Promises, Promises

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The debate over embryonic stem cells will surely go down in history as one of the great struggles of...well, what was (and is) it all about? It can be read as a clash between the liberating forces of scientific progress and repressive religion. Or as a case study in the way ethical issues posed by medical research get played out, and often distorted, when they become politicized. Or it might be framed as a striking instance of the power of national histories and cultures to shape public policy—that, at least, is how Thomas Banchoff, a professor of government at Georgetown University, understands how different national communities have dealt with the issue.

Banchoff looks at how embryonic stem-cell research has been debated and is conducted in four major countries: the United States, the United Kingdom, Germany, and France. The main outline of his narrative goes like this: In 1966 Drs. Edwards and Steptoe successfully fertilized a human egg outside the womb (IVF). In 1978, their work culminated in the birth of Louise Brown, the first “test tube” baby. Research that had been born in controversy ended with a great triumph, effectively wiping out conservative resistance and leading, by now, to hundreds of thousands of children conceived by IVF. One conclusion many of us drew at that time was that, whatever the ethical objections to the new medical technology, if it was successful in relieving important problems, it would almost certainly win in the court of public opinion, and legislators would soon follow.

The scientific story moves on from IVF’s use in treating infertility to the movement in the 1990s advocating the use of embryos for medical research, a proposal that attracted passionate proponents and equally passionate opposition. The debate was commonly cast as a straightforward ethical dilemma between the moral value of the human embryo and the moral value (often called a moral “imperative”) of saving lives and relieving suffering. That argument was more or less theoretical at first, but the isolation of embryonic stem cells in 1998 brought a radical change in the debate, seeming to open the door wide to what came to be called “regenerative medicine.” Visions of cures for many serious diseases were confidently projected and loudly touted. One prominent organization, the Alliance for Aging Research, claimed that some 150 million lives could be saved if the use of embryonic stem cells (thought to be more promising than the already available adult stem cells) were permitted for research.

At that point debates about the scientific use of embryos took on a supercharged life. Banchoff’s great and interesting contribution is to compare and contrast how the four “Atlantic Democracies” dealt with the issue, underlining in particular the jump in the intensity of the debate after the 1998 discoveries. The countries he chose reflect in many interesting ways their different cultures. The United Kingdom, long inclined to utilitarianism, was initially the most permissive about the use and destruction of embryos, including their creation for the purpose of research. The United States was more hesitant, ambivalently embracing and yet limiting the research use. Germany was even more restrictive, and the French somewhere in the middle. All the countries seemed open, in varying degrees, to making use of the spare embryos produced by IVF. The main resources Banchoff draws on for his analysis are the government commissions and inquiries established to develop national policies.

After 1998, however, all these nations began to drift in the direction of a greater openness to the research imperative. In the United States and France, the main opposition has come from religious groups, notably the Catholic Church. In France and Germany secular groups wary of technological hubris echoed in many ways the arguments of American conservatives (some religious, some not) that embryos are deserving of full human dignity and legal protection. But a combination of prominent scientists, commercial interests, disease-advocacy associations, media figures, and favorable media attention have gradually shifted the weight of the government commissions everywhere in favor of the research use of embryos.

Banchoff laments that “the greater political mobilization around stem-cell research and the polarization it generated reinforced the impoverishment of the public ethical debate.” On one side the advocates “were loath to admit that the research they so passionately supported raised any moral dilemmas at all.” On the other side the opponents “often refused to acknowledge the biological promise of embryonic stem cells,” lauding instead the promise of adult stem cells. Even so, the general trends of the debates everywhere showed “the centrality of the nation-state as the context for embryo politics over its first four decades.”

In an otherwise careful, nuanced examination of the ethical and political disputes, Banchoff himself falls into what has become a common trap. Like most of the commentary on this issue, Banchoff’s frames the ethical dilemma as a clash between the intrinsic value of the embryo as nascent human life and the value of the lives that could be saved by the future medical treatments that will be developed thanks to research. One might expect that Banchoff would closely scrutinize both values. Yet almost everyone who weighs in on this question focuses on the disputed moral claims made on behalf of the embryo. Little attention has been given to questioning the value of the proposed research, as if the efficacy of such research is too self-evident to merit examination.

Banchoff himself frequently invokes the moral “imperative” of research. Yet there are three reasons to question the widespread assumptions about the value of stem-cell research. The first is that the research has no assured outcome; it is only “promising,” not certain. By contrast, the death of the embryo is certain and irreversible. A second reason is that close to $3 billion a year is already being spent by the National Institutes of Health for research on the same diseases to be targeted by regenerative medicine. Those who complain that embryo research must be done to help cure disease usually fail to note that billions are already being spent in pursuit of that goal. In other words, the needs of the sick will not be neglected if funding for embryo research is curtailed. The third reason is that there has been no examination of the benefits that might accrue by spending the research money in other, perhaps better, ways, such as for basic health care. The “imperative” for research is given a free pass by Banchoff and by just about everyone else.

What has come of the research so far? All that “promise” is still far from being realized—there have been no major therapeutic breakthroughs. In fact, in recent years advocates have downplayed the clinical possibilities in favor of the better biological knowledge stem-cell research can bring. Perhaps the early hope and optimism will someday be realized; it would be foolish to deny that possibility. But it is not unfair to note that the past decades have seen a steady stream of well-advertised, promising medical advances that have yet to materialize. That is the way a good bit of medical science is presented to the public these days.